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L.C.H.

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L.C.H. last won the day on June 9

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    AP/CP general pathologist, BB medical director

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  1. In terms of hacking- we have two offline PCs, one here and one at our sister hospital, that contain backups of BB data for both hospitals (dont know how often we back it up though). we were hit by ransomware last June (downtime for a week in the middle of COVID, yay)and then found out IT had connected one of those two "offlines" to the network, and it was gone. We still had one lonely functioning PC, tho, with the entire systems' BB data, adn it got us through what was otherwise a very, very dicey time.
  2. thanks for all the responses! looks like most folks, like us, have the KBs read in hematology. And the inspector was OK with it; i think he'd just been looking at our BB personnel competency forms, but when he asked for the KB staff competencies he didnt like the (slightly different) format that our heme dept uses. He was a very seasoned inspector, so when he said BB, not heme, most often reads KBs, I just got curious if our institution is really an outlier in that respect. Seems not!! thanks!
  3. Greetings all - We are having an AABB inspection, and a curious question has come up. The inspector is accustomed to KBs being read by blood bank personnel, so any issuance of RhIg (more than the typical vial) is based ona result coming out of blood bank, and acted on by blood bank. However, in our lab, KBs are read by heme, and it's now created some confusion around which lab section 'owns' the competencies. Our heme lab uses a slightly different format for competencies (a problem in and of itself, but not the issue at hand), and the inspector is a bit discomfited by this. I have
  4. we require two types before issuing type-specific blood, and has to be two different samples from two different sticks. we bill for both.
  5. "Interesting topic, we had a 32 bed NICU and I don't remember ever transfusing platelets." we have a larger NICU, but have transfused plts to babies twice already this week, so it's not uncommon from where I sit. we have NAIT babies very frequently, as well as babies that bleed, drop their plts, need to go to surgery, and we bump their platelets first.
  6. If the antibody is no longer present in this pregnancy, then so far, so good! but some antibodies can wax and wane, and if this fetus is positive for an 'offensive' antigen, that antibody may start kicking up again in mom during the pregnancy. If you know which antibody caused it last time, you can look up and see if it is one that tends to wax and wane. Personally, I'd be concerned that the mom you describe could have HDFN again with this current fetus if the fetus has the offending antigen and mom's immune system catches wind of it. I am unclear on the recommendation that titering wo
  7. We've had this happen also, and in a perfect world I'd prefer the OBs resume titers in a bit (give the RhIg time to wane) to see if anti-D is shooting up. We've been burned twice in the past six months where OBs stopped checking titers and switched to Dopplers, which showed decreased risk of fetal anemia, and the babes came out with peripheral blood full of erythroid precursors - right on down to erythroblasts - requiring emergent exchange. So I personally would request a repeat titer closer to delivery, just so you know what you may be dealing with. I don't trust the Dopplers (sorry, ra
  8. Also low in southern new england; we were unable to make a full Rh-neg MTP pack this week for an Oneg postpartum bleed.... fortunately they didnt use all the reds and the Rh-pos came back to us. eesh!
  9. Malcolm, thank you for the article! I hope to get to it today. It appears cff DNA testing is available in the US for some things (DiGeorge, for instance), but I am not readily finding a lab that offers RHCE testing. Am going to keep looking. I guess my main concern is that since anti-c can kick up later in pregnancy, if we see an early anti-E in mom, should we advise to 1) test dad (or fetus with cff if i can find it) for not just E but also c antigen and/or 2) request an additional screen later in the pregnancy to see if anti-c has come up? (presuming mom is c-negative)
  10. ahh, i've been at a specialty hospital for too long, i forgot FOB is also fetal occult blood. :-)
  11. oops, John C. Staley - sorry for the abbreviations! MFM = maternal-fetal medicine; FOB = father of baby
  12. Hello, all - We've been having some back and forth with our MFM department and their handling of maternal antibodies. When the mom has an antibody, they test dad for the antigen, and then stop following if negative, and are resisting any change to this (see below for why i find this a problem). I pulled the ACOG Practice Bulletin 192, March 2018 and indeed that is the standard of care per ACOG (although there was NO reference for that entire section of the paper, so i dont know where that info came from). However, we had a case (with MFM) earlier this year where mom had an anti-E on
  13. Pathologist here. I realize this inquiry is kinda old now, and i am sorta curious to find out the resolution of this issue from the OP. I can see if the tech wanted to send a photo as a 'curbside' to see if it is a skiptocyte that maybe this would be OK, and up to the individual tech if they choose to use their phone for that. However, I find it a little weird (and bad practice) that the pathologist who is director is not around/onsite at least once a day to look at slides. If it's for a real review, then no, too bad. There are those numbered hashmarks on all scope stages so
  14. we have a 70 bed NICU in new england; we have about 3 neonatal exchanges each year. however, we've have had two in the past month; one for maternal:fetal ABO incompatibility (due to B, strangely), and one for anti-D HDN (no hydrops) that they tried to manage first with IVIG but after a couple weeks moved on to an exchange.
  15. Malcom Needs, thank you, I will check it out!
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